House Attending Rounds Again

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FootDocStudent

FootDocStudent

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Dr House says: I have a 33 year old Hispanic American woman who complains of migaine headaches, fever, blurry vision, depression, palpitations, weakness, both feet aching with burning pain, and trouble walking getting progressively worse for the past 5 days. She relates traveling to her homeland Puerto Rico to visit her parents 3 weeks ago. She did take Tylenol for the migraines and fever which helped a little. There were no changes in stools or urine, but positive anorexia. Her Family History consists of CHF, hypercholestrolemia, hypertension, Type 2 diabetes, and cancer. She is NKDA. Her PMH consists of appendicitis. She is a married homemaker with 2 young children and is a religious devout Catholic. Her labs show elevated WBCs and a temp of 100.2 F. Clinical findings showed subcutaneous reddish nodules on her trunk and B/L legs, ankles, and feet.

I am SUSPICIOUS of one disease that I feel needs top priority for work-up. What is on TOP of the differential diagnosis? 😕
 
She has some symptoms consistent with polyarteritis nodosa.
 
FootDocStudent said:
Dr House says: I have a 33 year old Hispanic American woman who complains of migaine headaches, fever, blurry vision, depression, palpitations, weakness, both feet aching with burning pain, and trouble walking getting progressively worse for the past 5 days. She relates traveling to her homeland Puerto Rico to visit her parents 3 weeks ago. She did take Tylenol for the migraines and fever which helped a little. There were no changes in stools or urine, but positive anorexia. Her Family History consists of CHF, hypercholestrolemia, hypertension, Type 2 diabetes, and cancer. She is NKDA. Her PMH consists of appendicitis. She is a married homemaker with 2 young children and is a religious devout Catholic. Her labs show elevated WBCs and a temp of 100.2 F. Clinical findings showed subcutaneous reddish nodules on her trunk and B/L legs, ankles, and feet.

I am SUSPICIOUS of one disease that I feel needs top priority for work-up. What is on TOP of the differential diagnosis? 😕
Click to expand...

It sounds like Dengue Fever.
 
jonwill said:
It sounds like Dengue Fever.
Click to expand...
Dr House says: OOOOOOOH!!! 😱 Interesting! You sound like a potential Attending for my Dept. Good thinking, but not quite. Try again. You are on the right track! :idea:
 
I like this, but can we keep the "lounge" type topics in 1 thread? No need for multiples.
 
What did the differential show, which WBC's were elevated?
 
densmore22 said:
Tsutsugamushi Fever.
Click to expand...

Dr House says: OOOOH! 😱 I think you figured out my hint. On the right track. I like this choice though. Getting there. One of my top 5 in the differential. Remember, I gave you all a HINT.
 
Kidsfeet said:
Meningitis. Any culture results from the tap?
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Dr House would say: I like this! Yes, this patient will eventually develop meningitis as a complication later on. 😉

Another hint: CSF culture is NEGATIVE. But still, possible meningitis. HMMMMMMMMMMMM???????? 🙄
 
Kidsfeet said:
Lymph node biopsy?

Malaria would be my next guess.
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Dr House says: No. Not malaria. Biopsy of lymph nodes is good thinking though. 😉 Good work. Lymph nodes could possibly see something for the disease I am suspicious of. But probably less likely.
 
rat lungworm disease/angiostrongyliasis
 
dpmPOD said:
rat lungworm disease/angiostrongyliasis
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Dr House says: Nice diagnosis! You are a sharp thinker! 😱 Indeed insightful. But not what I am looking for as number 1, yet this is in the top 10 diseases in the differential, maybe number 7 or 8. Good work. Try again 😉
 
gnathostomiasis (larval migrans profundus)
 
FootDocStudent said:
Dr House says: I have a 33 year old Hispanic American woman who complains of migaine headaches, fever, blurry vision, depression, palpitations, weakness, both feet aching with burning pain, and trouble walking getting progressively worse for the past 5 days. She relates traveling to her homeland Puerto Rico to visit her parents 3 weeks ago. She did take Tylenol for the migraines and fever which helped a little. There were no changes in stools or urine, but positive anorexia. Her Family History consists of CHF, hypercholestrolemia, hypertension, Type 2 diabetes, and cancer. She is NKDA. Her PMH consists of appendicitis. She is a married homemaker with 2 young children and is a religious devout Catholic. Her labs show elevated WBCs and a temp of 100.2 F. Clinical findings showed subcutaneous reddish nodules on her trunk and B/L legs, ankles, and feet.

I am SUSPICIOUS of one disease that I feel needs top priority for work-up. What is on TOP of the differential diagnosis? 😕
Click to expand...


Dr House says: I have a 6 year old Caucasian male with a fever that he's had for 5 days. Body temp. is 103 F. He also has erythematous palms and soles, and cherry red tongue and lips. His face is swollen. He has reddish skin rashes in his trunk. He is lethargic and weak. He has swollen lymph nodes in his neck. His eyes are really bloodshot red but no pus draining out. All these symptoms first began about 1 week ago and are getting worse. He also has heart palpitations and occasional chest pain and breathing problems. He also showed occassional hemoptysis. He has taken Tylenol but it did not help. He is NKDA. He has no past medical history. Family history consists of cancer, type 1 diabetes mellitus, and rheumatoid arthritis. He does go to day care on weekdays since both parents work. The family did travel to Ecquador for a trip since the father is an ecologist. I am SUSPICIOUS of one disease that is number 1 on my differential. What is the name of the disease that needs priority work up? 😕
 
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scrlet52 said:
kawasaki's disease
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Dr House says: You are correct. 😀 What year in podiatry school are you??? Are you one of those straight A students? Congrats anyway. Sooo... do you want to be a PGY-1 intern in my program? It is a unique residency program: multi disciplinary with medical doctors of different titles (MD, DO, OD, DC, DDS, DMD, MBBS, and DPM). Don't worry. Every PGY gets equal salary and benefits regardless of title. Offer is on the table. As long as you graduate and pass all three parts of your NPBME boards. Yes, pass part 3 boards.
 
FootDocStudent said:
Dr House says: I have a 33 year old Hispanic American woman who complains of migaine headaches, fever, blurry vision, depression, palpitations, weakness, both feet aching with burning pain, and trouble walking getting progressively worse for the past 5 days. She relates traveling to her homeland Puerto Rico to visit her parents 3 weeks ago. She did take Tylenol for the migraines and fever which helped a little. There were no changes in stools or urine, but positive anorexia. Her Family History consists of CHF, hypercholestrolemia, hypertension, Type 2 diabetes, and cancer. She is NKDA. Her PMH consists of appendicitis. She is a married homemaker with 2 young children and is a religious devout Catholic. Her labs show elevated WBCs and a temp of 100.2 F. Clinical findings showed subcutaneous reddish nodules on her trunk and B/L legs, ankles, and feet.

I am SUSPICIOUS of one disease that I feel needs top priority for work-up. What is on TOP of the differential diagnosis? 😕
Click to expand...

Dr House says: I have a 42 year old Caucasian woman with headaches, dizziness, fever, poor balance walking, abdominal pain, diarrhea, blood in the stools, legs and feet with numbess swelling pain and redness, swollen painful wrists ankles elbows knees and shoulders, red eyes and blurry vision/floaters, red tender papules and painful ulcers on the mouth, both legs and feet that have been getting worse for the past 2 weeks. She denies traveling. She works as a fashion designer. She is NKDA, married with 2 children. Her Past Medical History is cavities in the teeth, tooth abscess, hypertension, and pneumonia. Her family history is pancreas cancer, breast cancer, hypertension, type 2 diabetes mellitus, Down's Syndrome, leukemia, and hemophilia, Lyme Disease, and osteoarthritis. Her body temp is 102 F, she is tachypnic, acute distress, AAO x2, with S3 on auscultation, WBC count shows leukocytosis with segs and eosinophilia.

What disease am I suspicious of that is on top of the differential, numero uno? 😕😕😕
 
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With her family history of CA, has there been a Colonoscopy recently and if so, what were the findings?
 
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